For several decades, the preferred method of treating anatomical defects has been through the use of prosthetic materials of varied shapes and features. They are typically put and fixed into place by means of sutures, staples, tackers, biological glues or simply anchored on top of, below or on the defect. Tissue growth through the prosthetic mesh, which results from the body's reaction to a foreign object, then completes the repair.
In the specific case of inguinal hernias, the prosthesis typically consists of a mesh which is woven as a net of a specific fiber. Said prosthesis is put in the location to be treated and may then be cut and/or adjusted if necessary, so that its shape and size are perfectly adapted to the inguinal area where it will be implanted.
In patients of the male sex, so as to accommodate the spermatic cord, it is normally necessary to cut the prosthesis into two separate yet still attached leafs and then adapt them to the area so as to allow for the passage of said cord and the reinforcement of the internal inguinal ring. There are already today meshes that have these areas pre-cut and others which have the areas to be cut in surgery pre-defined on the prosthesis.
Patent document no. WO2006/034117 describes various embodiments of an implantable prosthesis which are similar to the present invention. The preferred embodiment described in patent document no. WO2006/034117 is a non-absorbable, ellipsoid and symmetric along its longest axis, implantable prosthesis with a non-continuous and non-absorbable ring which substantially follows the external border of the mesh with the exception of an indentation aimed at protecting the femoral vessels, said ring being attached by means of stitching on both sides of the ring all along its length, there being two reinforcements around the edges of the ring where it is discontinued so that these do not protrude out of the channel created by said sewing of the two layers of mesh. The implantable prosthesis described in patent document no. WO2006/034117 seems to have been designed in that way (i.e, having a discontinuous ring) so as to allow for the passage of the spermatic cord through the prosthesis during the treatment of indirect inguinal hernias.
The inventors of the present invention have determined that the surgery techniques for the treatment of inguinal hernias of the prior art are not the most suitable. Indeed, several advantages can be obtained if one opts for a new surgical technique developed by the inventors of the present invention and which consists of making a much higher entry incision, thus allowing for a much better access to the ideal location for placing prostheses of the abdominal wall and to the structures, as well as enabling an easier dissection of these, a large reduction of the risk of nerve damage, less aggressive impact and a reduction in post-operatory pain, as well as a significant reduction of the time of operation. The technique of this procedure involves a 3-4 cm transversal incision in the skin two fingers above the pubic symphysis, followed by a transversal incision of the external oblique aponeurosis (the only structure that is cut in the procedure) and a broad dissection of the pre-peritoneal area (Retzius space), the isolation of the structures of the spermatic cord, the identification of the Cooper ligament and the disruption of the Fascia Transversalis at that level. After this, one proceeds with the placement of a prosthesis (e.g., a pre-formed mesh with a memory ring) in the various locations of existing or potential defects and, after verifying a correct haemostasis, the surgeon sutures the external oblique aponeurosis and closes up the surgical intervention. As mentioned above, the prostheses currently known and used in the prior art are not suitable, namely because the rings have discontinuations (breaks) in them or it is necessary to make such discontinuations during surgery, particularly when operating on male patients.
A continuous ring increases the memory effect, as well as a more medial placement does not interfere with the subaponeurotic placement of the external part of the prosthesis, which enables a better adjustment to the new surgical technique described above that is used by the inventors, as well as a reduction of some complications resulting from the format of the prosthesis ring shown in document WO2006/034117.
The new surgical technique developed by the inventors, which is not yet part of the state of the art because it has not been publically disclosed, can not only be optimized with the prosthesis of the present invention but also vice-versa.